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Background and Objectives: Burn injuries are one of the most common traumas after traffic accidents, falls, and interpersonal violence. This study was done to investigate the correlation between psychological factors, pain, and sleep quality, and disability and occupational performance in subjects with hand and upper extremity burns. Methods: A total of 80 patients with hand and upper extremity burn injuries (16 females and 64 males) with a Mean±SD age of 39.9±10.79 years, mean burn depth (Deep Partial Thickness/ Full Thickness) of 3.42±2.66, and Mean±SD burns extent 1.06±0.24 participated in this non-experimental cross-sectional study using a non-probability sampling method. Their psychological disorders were measured using the Beck Anxiety Disorder Scale and the Self-Rating Depression Scale. The pain was assessed using the Visual Analogue Scale, sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI), disability was assessed using the Shortened Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, level of independence in daily living activity was measured by the Modified Barthel Index, and occupational performance was measured by the Canadian Occupational Performance Measure (COPM). Results: Psychological factors, pain, and sleep quality were significantly correlated with disability and occupational performance. The regression models explained up to 34.4% of the variance for disability outcome and 12.4% for occupational performance. By assessing the correlation between the psychological disorders, pain, and sleep quality, and disability and occupational performance in these patients, we found that sleep quality was the strongest contributing factor Followed by PSQI. Conclusion: Sleep quality is one of the important factors affecting the occupational performance of patients with hand and upper extremity burns injury that should be considered by therapists.

Anxiety is among the most debilitating nonmotor symptoms of Parkinson's disease (PD). This study aimed to determine how PD patients with low and high levels of anxiety (LA-PD and HA-PD, respectively) compare with age- and sex-matched controls at the level of motor control of reach-to-grasp movements during single- and dual-task conditions with varying complexity. Reach-to-grasp movement kinematics were assessed in 20 LA-PD, 20 HA-PD, and 20 sex- and age-matched healthy controls under single- as well as easy and difficult dual-task conditions. Assessment of PD patients was performed during both the on- and off-drug phases. The results obtained during dual-task conditions reveal deficits in both reach and grasp components for all three groups (e.g., decreased peak velocity and delayed maximum hand opening). However, these deficits were significantly greater in the PD groups, especially in the HA-PD group. Although dopaminergic medication improved reach kinematics, it had no effect on grasp kinematics. The results of our study indicated that high levels of anxiety may enhance the inefficiency of upper limb motor control in PD patients, especially during high demanding cognitive conditions, and should, therefore, be considered in the assessment and planning of interventions for upper limb function in these patients.

Neuropathic pain is a type of pain reported in people with Parkinson’s disease. There are various scales to evaluate the characteristics of this kind of pain. The purpose of this study was to investigate the psychometric properties of the Neuropathic Pain Symptom Inventory (NPSI), a specific scale that measures neuropathic pain in Iranian people with Parkinson’s disease. Four hundred forty-seven individuals with Parkinson’s disease were recruited in the study. Acceptability, internal consistency (Cronbach’s alpha), and test-retest reliability (intraclass correlation coefficient, ICC) of NPSI were calculated. Dimensionality was examined through exploratory factor analysis. For convergent validity, correlations of NPSI with Douleur Neuropathic 4, Brief Pain Inventory, King’s Pain Parkinson disease Scale, and Visual Analog Scale-Pain were used. Discriminative validity and sensitivity to change between On- and Off- medication states were analyzed. A marked floor effect was observed for this scale (64.2%). Cronbach’s alpha and ICC were 0.90 and 0.87, respectively. Items of NPSI were placed in 4 factors. A moderate to the strong association (rs = 0.55 to 0.85) between NPSI and other scales was obtained. The results of discriminative validity and sensitivity to change indicate the ability of NPSI to show differences between medication states. The results of this study suggest that NPSI has acceptable reliability, validity, and sensitivity to change, indicating that this scale is suitable for measuring neuropathic pain in Iranian people with Parkinson’s disease.

Meaningful Activity Participation Assessment (MAPA) is an appropriate tool for assessing both objective and subjective aspects of participation.This study aimed to investigate the psychometric properties of MAPA in chronic stroke survivors.Translation of MAPA was done according to the standard protocol of forward-backward translation. One hundred and seven chronic stroke survivors participated in this study. In addition to the MAPA, they were assessed by Satisfaction With Life Scale (SWLS), Center for Epidemiologic Studies of Depression Scale (CES-D), Life Satisfaction Index-Z (LSI-Z), Purpose in Life Test-Short Form (PIL-SF), and 36-Item Short-Form Survey (SF-36). To investigate the test-retest reliability, 37 participants were reassessed by MAPA after two weeks. Reliability, construct and known-groups validity were evaluated for MAPA.The results showed an acceptable internal consistency (Cronbach's α = 0.79) and good test-retest reliability (ICC = 0.92) of MAPA. A significant moderate to high correlation was found between the MAPA and PIL-SF, CES-D, LSI-Z, SWLS, and different subscales of SF-36 (r = 0.32-0.65). MAPA showed good ability to differentiate between young adults (age≤ 65 years) and older adults (age65 years) with chronic stroke (The MAPA has appropriate reliability and validity in chronic stroke survivors and is suggested to be used in research and clinical settings.

Background and Objectives: To investigate the correlation between reach and grasp kinematic measures and clinical measures of gross and fine manual dexterity in patients with idiopathic Parkinson Disease (PD). Methods: Sixty patients (44 men, 16 women) with idiopathic PD (Mean±SD of age: 59.85±11.89 years) were recruited in this non-experimental cross-sectional study using a non-probability sampling method. Their gross and fine manual dexterity were assessed using the Box and Block Test (BBT) and Nine Hole Peg Test (NHPT), respectively. Also, reach and grasp kinematic measures (including normalized movement time, peak velocity, Maximum Grip Aperture [MGA], and percentage of movement time in which MGA occurred [PMGA]) were measured in the more affected hand. Results: The results showed a significant and moderate correlation between reach kinematic measures (i.e. normalized movement time and peak velocity) and both gross and fine manual dexterity assessed by BBT (P=0.000) and NHPT (P=0.000), respectively. However, there was not a significant correlation between grasp kinematic measures (i.e. MGA and PMGA) and gross manual dexterity measured by BBT (P>0.05) as well as fine manual dexterity assessed by NHPT (P>0.05). Conclusion: This study showed no to moderate correlation between reach and grasp kinematic measures and clinical measures of gross and fine manual dexterity in patients with PD, supporting the significance of multi-level evaluation using both clinical and kinematic measures in the evaluation of upper limb function in patients with PD.

Purpose. Pain is one of the nonmotor symptoms of Parkinson’s disease (PD) that, in order to be better managed, requires to be evaluated. Evaluations are done using pain assessment scales such as the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2). The goal of this study was to assess the psychometric properties of SF-MPQ-2 to measure pain in people with PD. Methods. Four hundred and twenty-eight PD patients with a mean (SD) age of 60.11 (11.44) years were included. Accessibility was measured through floor and ceiling effects. Dimensionality was estimated by exploratory factor analysis. The association between SF-MPQ-2 and other scales such as Neuropathic Pain Symptom Inventory, Douleur Neuropathic 4, Brief Pain Inventory, King’s Pain Parkinson’s Disease Scale, and Visual Analog Scale-Pain was considered to calculate convergent validity. Internal consistency and test-retest reliability were assessed by Cronbach’s alpha and intraclass correlation coefficient (ICC), respectively. Results. A noticeable floor effect was found. Dimensionality results indicated four factors for this scale. A strong relationship was found between the SF-MPQ-2 total score and other scales (r = 0.55 to 0.85). In reliability analysis, Cronbach’s alpha and ICC were 0.93 and 0.94 for SF-MPQ-2, respectively. Conclusion. The results of this study showed that SF-MPQ-2 has adequate validity and reliability to measure pain in people with Parkinson’s disease.

Purpose Patients with idiopathic Parkinson's disease (PD) suffer from different non-motor symptoms, including pain. The present study aimed to measure the psychometric properties of the Brief Pain Inventory (BPI) in patients with PD during ON- and OFF-states. Methods We recruited 460 patients with PD and 100 non-PD controls. The pain was assessed by the BPI, King's Parkinson's disease Pain Scale (KPPS), Neuropathic Pain Symptom Inventory (NPSI), Visual Analogue Scale-Pain (VAS-pain), and short-form McGill Pain Questionnaire-2 (SF-MPQ-2) in both medication states. Internal consistency and test-retest reliability was examined using Cronbach's alpha coefficient and intra-class correlation coefficient (ICC). Dimensionality and convergent validity of BPI were also investigated. Diagnostic accuracy and discriminative validity were determined by Receiver Operating Characteristics (ROC) curve analysis and Area Under the Curve (AUC). Results Cronbach's alpha was satisfactory (α = 0.91-0.97) in both states. The ICC values were 0.85-0.96 in ON- and OFF-state. Factor analysis revealed two factors. A high correlation was obtained between BPI subscales and other scales. AUC >0.91, sensitivity, and specificity> 0.77 were observed for discriminating different pain levels. Furthermore, appropriate diagnostic accuracy was found (AUC, sensitivity, and specificity >0.67) between non-PD control and PD patients. Conclusion The BPI has acceptable psychometric features as well as diagnostic accuracy for patients with PD.Implications for rehabilitationPain as a non-motor symptom in PD can affect daily and social activities.The BPI is used to assess pain severity and interference in activities.For better treatment, pain should be assessed in off-state like to on-state.BPI has satisfactory reliability and validity in different medication states in PD.

Dexterity is one of the most critical upper extremity functions that may be impaired in chronic stroke survivors. This study aimed to investigate the psychometric properties of DextQ-24 in Iranian chronic stroke survivors.A total of 123 people with chronic stroke were included in the study. Internal consistency and test-retest reliability were assessed through Cronbach's alpha and Interclass Correlation (ICC), respectively. Dimensionality was performed by Exploratory Factor Analysis. In addition, to assess the convergent validity of DextQ-24, Box and Block Test, Motor Activity Log Questionnaire, ABILHAND Questionnaire, and Purdue Pegboard Test were used. Discriminant validity of DextQ-24 was measured between different stages of recovery (Brunnstrom stage). Acceptability was calculated by ceiling and floor effect.Cronbach's alpha and ICC were 0.92 and 0.91, respectively. The 24 items of this questionnaire were classified into six components. Further, a moderate to strong correlation between the total score of DextQ-24 with other tools | r = 0.41-0.84 | was obtained. The results of discriminant validity approved the ability of the total score of DextQ-24 to separate different stages of recovery. The results also reported that this questionnaire did not have a significant ceiling and floor effect.The results of our study showed that the Persian DextQ-24 has high reliability and a good convergent and discriminant validity in people with chronic stroke for dexterity measurement as a PROM questionnaire.

Background Impaired postural control in Parkinson’s disease (PD) seriously compromises life quality. Although balance training improves mobility and postural stability, lack of quantitative studies on the neurophysiological mechanisms of balance training in PD impedes the development of patient-specific therapies. We evaluated the effects of a balance-training program using functional balance and mobility tests, posturography, and a postural control model. Methods Center-of-pressure (COP) data of 40 PD patients before and after a 12-session balance-training program, and 20 healthy control subjects were recorded in four conditions with two tasks on a rigid surface (R-tasks) and two on foam. A postural control model was fitted to describe the posturography data. The model comprises a neuromuscular controller, a time delay, and a gain scaling the internal disturbance torque. Results Patients’ axial rigidity before training resulted in slower COP velocity in R-tasks; which was reflected as lower internal torque gain. Furthermore, patients exhibited poor stability on foam, remarked by abnormal higher sway amplitude. Lower control parameters as well as higher time delay were responsible for patients’ abnormal high sway amplitude. Balance training improved all clinical scores on functional balance and mobility. Consistently, improved ‘flexibility’ appeared as enhanced sway velocity (increased internal torque gain). Balance training also helped patients to develop the ‘stability degree’ (increase control parameters), and to respond more quickly in unstable condition of stance on foam. Conclusions Projection of the common posturography measures on a postural control model provided a quantitative framework for unraveling the neurophysiological factors and different recovery mechanisms in impaired postural control in PD. Electronic supplementary material The online version of this article (10.1186/s12984-019-0574-0) contains supplementary material, which is available to authorized users.

Objectives To investigate the effects of competitive and noncompetitive volleyball exercises on the functional performance and motor control of the upper limbs in chronic stroke survivors. Design Randomized clinical trial. Setting Outpatient rehabilitation center. Participants Chronic stroke survivors (N=48). Interventions Participants were randomly assigned to competitive (n=16) or noncompetitive (n=16) volleyball exercise groups (60min/d volleyball exercise+30min/d traditional rehabilitation, 3d/wk for 7wk) and control group (n=16). Main Outcome Measures Reach and grasp motor control measures were evaluated through kinematic analysis. Functional outcomes were assessed via Motor Activity Log, Wolf Motor Function Test (WMFT), Box and Block Test, and Wrist Position Sense Test. Results Significant improvement of functional performance was observed in both competitive (P .05), with the exception of WMFT score. Volleyball training, in general, resulted in more efficient spatiotemporal control of reach and grasp functions, as well as less dependence on feedback control as compared to the control group. Moreover, the competitive volleyball exercise group exhibited greater improvement in both functional performance and motor control levels. Conclusions Volleyball team exercises, especially in a competitive format, resulted in enhancing the efficacy of the preprogramming and execution of reach and grasp movements, as well as a shift from feedback to feedforward control of the affected upper limb in chronic stroke survivors. This may well be a potential underlying mechanism for improving functional performance.

Introduction: Freezing of gait, a common PD motor symptom, could increase the risk of falling. This study aimed to investigate the clinimetric attributes of the Freezing of Gait Questionnaire (FOGQ) for people with Parkinson disease in the “off” state. Methods: A total of 115 patients with Parkinson disease (PD; mean age, 60.25 years) were included. Acceptability, internal consistency (by the Cronbach alpha, and test-retest by Intraclass Correlation [ICC]), and reliability of the Persian-translated version of the FOGQ were examined. Dimensionality was estimated by Exploratory Factor Analysis (EFA). Fall efficacy scale-international, unified Parkinson disease rating scale-II, Berg balance scale, functional reach test, and Parkinson disease questionnaire-39 were applied to determine the convergent validity. Diagnostic accuracy for obtaining optimal cutoff point, separating faller and non-faller groups, was analyzed by Receiver Operating Characteristics (ROC) curve analysis and Area Under the Curve (AUC). All tests were carried out in an “off” state. Results: The Cronbach alpha was high (α=0.92). The test-retest showed high reliability (ICC=0.89). The FOGQ was unidimensional according to the EFA and had acceptable convergent validity with moderate to high correlation with other clinical scales. The optimal cutoff point to discriminate fallers from non-fallers during the “off” state was 9/10, with an AUC of 0.92. Conclusion: Our results suggest that the FOGQ has appropriate reliability, validity, and discriminative ability for measuring FOG in patients with PD during the “off” state.

Purpose To investigate the reliability and validity of Parkinson's Disease-Cognitive Rating Scale (PD-CRS) in Iranian patients with idiopathic PD. Methods One hundred and eighty patients with PD and 60 age-, gender-, and educational level-matched healthy individuals participated in this study. Inter-rater and test-retest reliability of the Persian version of PD-CRS was investigated in 80 patients with PD. To evaluate the construct validity of the PD-CRS, its correlation with the Scales for Outcomes in Parkinson's disease-Cognition (SCOPA-Cog), Mini-Mental State Examination, Montreal Cognitive Assessment, Clock Drawing Test, Unified Parkinson's Disease Rating Scale-Section I, and Quick Dementia Rating System was assessed. To assess the diagnostic accuracy of the PD-CRS, patients with PD were classified as groups with normal cognitive function, mild cognitive impairment (MCI), and dementia using the Clinical Dementia Rating. Results Test-retest and inter-rater reliability (ICC > 0.90), as well as internal consistency (α = 0.94) of the Persian version of PD-CRS, were excellent. A high positive correlation was found between the PD-CRS and SCOPA-Cog. A cut-off point of ≤79 (sensitivity 98.15% and specificity 98.04%) and ≤62 (sensitivity 100%, and specificity 100%) on the PD-CRS total score was obtained for detecting MCI and dementia in PD patients, respectively. Conclusions The results of this study showed that the Persian version of PD-CRS is a reliable and valid measure with high sensitivity and specificity to identify MCI and dementia in patients with PD. Implications for rehabilitation The PD-CRS has an excellent test-retest and inter-rater reliability and validity in Iranian patients with PD. The PD-CRS has high sensitivity and specificity for discriminating between different levels of cognitive impairment (i.e. no cognitive impairment, mild cognitive impairment, and dementia) in Iranian patients with PD.

This study was designed to investigate the effects of anxiety and dual-task on reach and grasp motor control in chronic stroke survivors compared with age- and sex-matched healthy subjects (HC). Reach and grasp kinematic data of 68 participants (high-anxiety stroke (HA-stroke), n = 17; low-anxiety stroke (LA-stroke), n = 17; low-anxiety HC, n = 17; and high-anxiety HC, n = 17) were recorded under single- and dual-task conditions. Inefficient reach and grasp of stroke participants, especially HA-stroke were found compared with the control groups under single- and dual-task conditions as evidenced by longer movement time (MT), lower and earlier peak velocity (PV) as well as delayed and smaller hand opening. The effects of dual-task on reach and grasp kinematic measures were similar between HCs and stroke participants (i.e., increased MT, decreased PV that occurred earlier, and delayed and decreased hand opening), with greater effect in stroke groups than HCs, and in HA-stroke group than LA-stroke group. The results indicate that performing a well-learned upper limb movement with concurrent cognitive task leads to decreased efficiency of motor control in chronic stroke survivors compared with HCs. HA-stroke participants were more adversely affected by challenging dual-task conditions, underlying importance of assessing anxiety and designing effective interventions for it in chronic stroke survivors.

Background Despite the high prevalence of anxiety among chronic stroke survivors and evidence of its negative effects on postural control in healthy subjects, it is unclear whether anxiety also affects postural control in these patients. Recent evidence of improved postural control of healthy subjects by distracting the attention using an external focus (EF) or cognitive task, raises the question of whether similar benefits would be observed in stroke survivors. Thus, the current study aimed to investigate the effects of anxiety and distracting the attention on postural control of chronic stroke survivors in terms of both postural sway measures and neuromuscular regulation. Methods Postural sway measures and ankle muscle activity of chronic stroke survivors with the high and low level of anxiety (HA-stroke (n = 17), and LA-stroke (n = 17), respectively) and age-, sex-, height-, and weight-matched healthy subjects (n = 17) were assessed while standing on rigid and foam surfaces under following conditions: baseline, internal focus (IF), EF, simple and hard cognitive tasks (SC and HC, respectively). Results Stroke survivors, particularly HA-stroke participants, showed greater postural sway measures (i.e. postural instability) and enhanced co-contraction of ankle muscles (i.e. stiffening of the neuromuscular system) compared with healthy subjects. As opposed to baseline and IF conditions, postural instability and neuromuscular stiffening significantly reduced in EF condition and decreased more in cognitive task conditions, particularly HC condition. Conclusions The results suggest that anxiety enhances stroke-induced postural instability promoting improper neuromuscular control of posture with stiffening strategy, which can be alleviated by EF and cognitive tasks.

This study aimed to investigate the ability of the Quick Dementia Rating System (QDRS) to discriminate patients with PD who have mild cognitive impairment from those without cognitive impairment and those with dementia.A total of 105 patients with PD were classified as without cognitive impairment (The cut-off point2.5 (sensitivity = 86.96%, area under curve (AUC) = 0.88) was obtained for discriminating patients with mild cognitive impairment from those without cognitive impairment based on the total score of QDRS. The cut-off point5 (sensitivity = 84%, AUC = 0.84) was derived for discriminating mild cognitive impairment from dementia based on the total score of QDRS.The results of this study showed a good discriminative validity of the QDRS for discriminating mild cognitive impairment from no cognitive impairment and dementia in patients with PD.IMPLICATIONS FOR REHABILITATIONThe Quick Dementia Rating System has a good discriminative validity for diagnosing mild cognitive impairment from normal cognitive function in Parkinson's disease.The Quick Dementia Rating System has a good discriminative validity for diagnosing mild cognitive impairment from dementia in Parkinson's disease.The Quick Dementia Rating System could be suggested as a routine rapid cognitive screening tool for patients with Parkinson's disease.

Background Balance training improves postural control in Parkinson’s disease (PD). However, a systematic approach for the development of individualized, optimal training programs is still lacking, as the learning dynamics of the postural control in PD, over a training program, are poorly understood. Objectives We investigated the learning dynamics of the postural control in PD, during a balance-training program, in terms of the clinical, posturographic, and novel model-based measures. Methods Twenty patients with PD participated in a balance-training program, 3 days a week, for 6 weeks. Clinical tests assessed functional balance and mobility pre-training, mid-training, and post-training. Center-of-pressure (COP) was recorded at four time-points during the training (pre-, week 2, week 4, and post-training). COP was used to calculate the sway measures and to identify the parameters of a patient-specific postural control model, at each time-point. The posturographic and model-based measures constituted the two sets of stability- and flexibility-related measures. Results Mobility- and flexibility-related measures showed a continuous improvement during the balance-training program. In particular, mobility improved at mid-training and continued to improve to the end of the training, whereas flexibility-related measures reached significance only at the end. The progression in the balance- and stability-related measures was characterized by early improvements over the first 3 to 4 weeks of training, and reached a plateau for the rest of the training. Conclusions The progression in balance and postural stability is achieved earlier and susceptible to plateau out, while mobility and flexibility continue to improve during the balance training.

Background: Light touch, one of the primary and basic sensations, is often neglected in sensory retraining programmes for stroke survivors.Objective: This study aimed to investigate the effects of ...

This study aimed at determining validity, reliability, and diagnostic accuracy of Coin Rotation Task (CRT) in assessing manual dexterity and coordination of children with specific learning disorder (SLD). In this non-experimental cross-sectional study, 120 children (typically developing children = 60, children with SLD = 60, mean age ± SD =9.18 ± 0.55) were recruited. Test–retest reliability and construct validity of CRT were assessed. Multivariate regression analysis was performed on CRT scores by considering age and gender as covariates and children with SLD with mild dexterity impairment and severe dexterity impairment (SDI) as outcome variables. Receiver-operating characteristics (ROC) curve analysis was carried out to derive validity parameters. Test-retest reliability of the CRT scores in both subtests were excellent in children with SLD (ICC2,1: 0.93–0.95) and good to excellent in typically developing children (ICC2,1: 0.72–0.82). Acceptable construct validity of CRT was also found. The CRT cut-off points were 23 (sensitivity= 89.29%, specificity= 70.37%) and 28 (sensitivity= 80.33%, specificity= 86.36%) for discriminating children with SLD and SDI from typically developing children in dominant and non-dominant hand, respectively. The present study indicated good to excellent test-retest reliability, acceptable validity, and high diagnostic accuracy for diagnosing children with SLD based on their dexterity impairment level.Implications for RehabilitationThe Coin Rotation Task (CRT) was modified and validated for use in children.The CRT is a reliable and valid tool with high diagnostic accuracy.The CRT has a good ability for discriminating children with specific learning disorder with severe dexterity impairment form typically developing children.Treatment plans and research designs can be performed by using this valid, reliable, and easy to administer tool. The Coin Rotation Task (CRT) was modified and validated for use in children. The CRT is a reliable and valid tool with high diagnostic accuracy. The CRT has a good ability for discriminating children with specific learning disorder with severe dexterity impairment form typically developing children. Treatment plans and research designs can be performed by using this valid, reliable, and easy to administer tool.

Objective: To determine the effect of mirror visual feedback (MVF) on disability, pain, and motor function on patients who underwent hand reconstructive surgery. Design: Randomized, single-blinded controlled trial. Setting: Rehabilitation center. Subjects: A total of 40 patients who were randomly assigned into the intervention group ( n = 20) and control group ( n = 20) participated in this study. Interventions: The rehabilitation sessions took place twice a week for eight weeks. The control group received traditional rehabilitation for 75 minutes. While the intervention group performed MVF and traditional rehabilitation for 30 and 45 minutes, respectively. Measures: Pain and disability of the hand were assessed with McGill pain questionnaire and Disability of Arm, Shoulder, and Hand (DASH) scores. The range of joint motion was evaluated by Goniometer, and the strength of grip and pinch was evaluated by Dynamometer and Pinch gauge and dexterity evaluated by Minnesota Manual Muscle test. Results: The results indicated that both traditional and MVF methods induced significant decreasing pain (Pain Rate Index: F = 68.48, P = 0.000; Number of Word Count: F = 70.96, P = 0.000), disability ( F = 50.08, P = 0.000) and increasing dexterity (placing test: F = 28.73, P = 0.000), and range of motion ( F = 33.16, P = 0.000). The results also showed that the positive effect of MVF on pain, disability, dexterity, and range of motion was significantly greater than that of controls ( P 0.05). Conclusion: MVF, in conjunction with traditional rehabilitation programs, may lead to greater improvements in pain, disability, placing dexterity, and range of motion. But it seems not to be effective on pinch and grip power and turning dexterity.

Background/Aims: Mirror visual feedback is an intervention that focuses on watching the movements of the intact hand in the mirror to restore the movements of the injured hand. This method is developed based on the concept of the central reflection of the amputated or injured limb. This study aims to determine the effect of mirror visual feedback as a complementary method on the outcomes of sensory relearning in patients following median/ulnar nerve repair. Methods: This randomised clinical trial was conducted on 20 patients with median/ulnar nerve damage who were selected through convenience sampling and were then randomly assigned to a treatment and a control group. Both groups received traditional rehabilitation in three 40-minute sessions a week. In addition, the treatment group received mirror visual feedback 15 minutes a day, 5 days a week, for 8 weeks. The patients' sensory status was assessed using Semmes-Weinstein Monofilaments and two-point discrimination tests and their sensory function was assessed using stereognosis both before and after the intervention. Findings: The final analysis was performed on a total of 20 patients. The Semmes-Weinstein Monofilaments test and two-point discrimination scores obtained showed significant improvements following therapy in both groups. The changes in Semmes-Weinstein Monofilaments test (P=0.000], two-point discrimination (P=0.000) and stereognosis (active: P=0.001, passive: P=0.000) scores were significantly greater in the mirror therapy group compared to the controls. Conclusions: Mirror visual feedback in conjunction with traditional sensory retraining programmes led to greater improvements in superficial sensation and touch discrimination of the hand in the first phase of the sensory relearning programme. This may be due to the use of the neuroplasticity potential, the stimulation of the somatosensory areas and motor networks, the adjustment of early cortical reorganisation and the prevention of further changes.

Having an appropriate tool for assessment of the balance status during the drug off-phase in idiopathic Parkinson’s disease (PD) is relevant for clinical and research settings. Our objective was to assess the clinimetric properties of the Berg balance scale (BBS) during drug off-phase in PD. Balance of 98 PD patients (mean age ± SD, 59.19 ± 10.88 years) was evaluated with the BBS. Other assessments in the study included the Fall Efficacy Scale-International (FES-I), Functional Reach Test (FRT), Section II of the Unified Parkinson’s Disease Rating Scale-3.0, Parkinson’s Disease Questionnaire-39 (PDQ-39), and Schwab and England Activities of Daily Living Scale. All evaluations took place during the drug off-phase. Internal consistency and inter- and intra-rater reliability were evaluated by Cronbach’s alpha coefficient and intraclass correlation coefficient, respectively. Dimensionality was explored by factor analysis. Discriminative validity was tested by comparing BBS score between PD patients with and without a history of falling. Internal consistency was high (α = 0.98), as were intra- and inter-rater reliability (ICC = 0.98 and 0.95, respectively). Factor analysis identified only one dimension for the BBS, whose convergent validity with FES-I, FRT, and domain mobility of the PDQ-39 were moderate or high (rS = |0.60–0.74|). Correlation of BBS with functional scales and PDQ-39 Summary Index was moderate (rS = |0.45–0.62|). Finally, the BBS showed a moderate strength to discriminate between PD patients with and without a history of falling. Our study suggests that BBS has satisfactory internal consistency, reliability, and construct validity for measuring functional balance in people with PD during the drug off-phase.

Background and Objective: Fear of falling is a major problem among people suffering from stroke. This study aimed to investigate the relationship between functional balance (FB) and fear of falling (FOF) in chronic stroke patients with and without history of falling and to identify the best measurement tool for FB which can assess the FOF in these patients. Methods: Eighty-two participants with chronic stroke with the mean age of 54.90 (±11.30) years participated in this non-experimental cross sectional study. They were divided into faller and non-faller groups based on their history of falling during the last month. The FB was measured by Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Tinetti Balance Test, and Functional Reach Test (FRT). The Persian versions of the self-completed Fall Efficacy Scale-International (FES-I) and Activity-specific Balance-Confidence scale (ABC) were used to evaluate FOF. Results: The results of this study showed that the correlation between FES-I with FRT, BBS, DGI and Tinetti Balance Test were -0.38, -0.67, -0.44 and -0.62, in faller group and -0.11, -0.59, -0.31 and -0.24 in non-faller group. The correlation between ABC and FRT, BBS, DGI and Tinetti Balance Test were 0.58, 0.48, 0.68 and 0.57 in faller group and 0.17, 0.55, 0.45 and 0.44 in non-faller group. The results of multiple regression analysis showed that BBS was the best predictor for FOF (which explained 25% and 31% of total variance of FES-I and ABC in faller group as well as 68% and 42% of total variance of FES-I and ABC in non-faller group). Conclusion: The results of this study showed a low to moderate correlation between FB and FOF in both groups of faller and non-faller chronic stroke patients. Furthermore, BBS seems to be the best functional balance measurement to predict FOF in these patients.

BACKGROUND: Although impaired postural control may be a risk factor for distal radius fractures (wrist fractures), which often are caused by falls, little attention has been given thus far to the various performance and neurophysiologic aspects involved. Although studies suggest that external focus and cognitive tasks can improve postural control, it remains unclear whether these benefits are observed in individuals with a history of distal radius fracture and to what extent. QUESTIONS/PURPOSES: (1) To compare patients with a history of distal radius fracture to age- and sex-matched controls in terms of postural stability while standing on stable and unstable support surfaces, using both postural sway and neurophysiological measures as endpoints; and (2) to determine whether internal- and external-focus strategies and cognitive tasks can improve postural stability in these patients. METHODS: Forty patients with distal radius fracture (33 females and seven males with a mean ± SD age of 56 ± 4 years) and 40 sex- and age-matched control participants participated in the study. We recruited patients with a history of fall-induced distal radius fractures occurring between 6 and 24 months before the start of our study. We excluded patients who had any of the following: fear of falling, taking any medication that may affect balance, neurologic disorders, dizziness, vestibular problems, Type II diabetes, musculoskeletal disorders or recent history of lower extremity fracture, any recent surgical interventions in the spine or lower limbs, and/or cognitive impairment. Of 120 patients who were being treated for distal radius fracture over the 18-month period, 91 (76%) agreed to participate and 40 eligible patients were finally enrolled. The control group included sex- and age-matched (within 2-year intervals) individuals who had never had a wrist fracture. This group was selected from attendants/relatives of the patients attending the neurology and physical medicine and rehabilitation outpatient departments, as well as other volunteers with no history of balance problems or wrist fractures. To address our primary research question, we compared the postural control of individuals with a history of distal radius fracture with the control group while quietly standing on different support surfaces (rigid and foam surfaces) using both postural sway measures obtained by a force plate as well as neurophysiological measures (electromyography [EMG] activity of tibialis anterior and medial gastrocnemius). To address our secondary research question, we compared the postural sway measures and EMG activity of the ankle muscles between different experimental conditions (baseline, internal focus (mentally focusing on their feet without looking), external focus (mentally focusing on rectangular papers, placed on the force plate or foam, one under each foot), difficult cognitive task (recalling maximum backward digits plus one) and easy cognitive task (recalling half of the maximum backward digits). RESULTS: Patients with distal radius fractures presented with greater postural sway (postural instability) and enhanced ankle muscle activity compared with their control counterparts, but only while standing on a foam surface (mean velocity: 5.4 ± 0.8 versus 4.80 ± 0.5 [mean difference = 0.59, 95% CI of difference, 0.44–0.73; p < 0.001]; EMG root mean square of the tibialis anterior: 52.2 ± 9.4 versus 39.30 ± 6 [mean difference = 12.9, 95% CI of difference, 11.4–14.5; p < 0.001]). Furthermore, a decrease in postural sway was observed while standing on both rigid and foam surfaces during the external focus, easy cognitive, and difficult cognitive conditions compared with the baseline (for example, mean velocity in the baseline condition compared with external focus, easy cognitive task and difficult cognitive task was: 4.9 ± 1.1 vs 4.7 ± 1 [mean difference = 0.14, 95% CI of difference, 0.11–0.17; p < 0.001], 4.6 ± 1 [mean difference = 0.25, 95% CI of difference, 0.21–0.29; p < 0.001], and 4.5 ± 1 [mean difference = 0.34, 95% CI of difference, 0.29–0.40; p < 0.001] in the wrist fracture group). The same result was obtained for muscle activity while standing on foam (EMG root mean square of tibialis anterior in the baseline condition compared with external focus, easy cognitive task and difficult cognitive task: 58.8 ± 7.2 versus 52.3 ± 6.6 [mean difference = 6.5, 95% CI of difference, 5.5–7.6; p < 0.001], 48.8 ± 7.1 [mean difference = 10.1, 95% CI of difference, 9–11.1; p < 0.001], 42.2 ± 5.3 [mean difference = 16.7 95% CI of difference, 15.1–18.2; p < 0.001] in the wrist fracture group). CONCLUSIONS: The current results suggest that patients with a history of distal radius fractures have postural instability while standing on unstable support surfaces. This instability, which is associated with enhanced ankle muscle activity, conceivably signifying an inefficient cautious mode of postural control, is alleviated by external attention demands and concurrent cognitive tasks. CLINICAL RELEVANCE: The findings of this study may serve as a basis for designing informed patient-specific balance rehabilitation programs and strategies to improve stability and minimize falls in patients with distal radius fractures. The integrative methodology presented in this work can be extended to postural control and balance assessment for various orthopaedic/neurological conditions.

Background Independence in activities of daily living (ADL) is one of the most important aspects in planning treatment for people with Parkinson disease (PD). The Barthel Index (BI) and modified Rankin Scale (mRS) are commonly used in neurological diseases. Objective This study was conducted to confirm the validity and reliability of the BI and mRS in PD during ON and OFF medication phases. Methods We included 260 individuals with a diagnosis of idiopathic PD. The disability in ADL was measured by the BI, mRS, Parkinson's Disease Questionnaire-39 (PDQ-39), Unified Parkinson Disease Rating Scale-Activities of Daily Living (UPDRS-ADL), and Schwab and England ADL scale (SE). Test–retest, inter-rater reliability, and internal consistency were assessed by the intra-class correlation (ICC) and Cronbach α coefficients. Dimensionality was evaluated by factor analysis. Convergent validity was assessed by the SE, Berg Balance Scale (BBS), PDQ-39 and UPDRS-ADL. Results For the 260 participants (187 [71.9%] males; mean [SD] age 60.3 [12.3] years), both the BI and mRS achieved an acceptable level of test–retest and inter-rater reliability (ICC = 0.77 to 0.91) in ON and OFF medication phases. The Cronbach α for BI was 0.85 and 0.88, respectively. We found 1 and 2 factors for BI in ON and OFF phases, respectively. Investigation of convergent validity showed moderate to high correlation for the BI with the UPDRS-ADL, SE, PDQ-39 (ADL), BBS and mRS scores in ON and OFF phases (ρ = 0.51–0.74) and mRS with SE, UPDRS-ADL, PDQ-39 (ADL) and BBS scores (ρ = 0.48–0.82). Conclusion The BI and mRS showed acceptable validity and reliability to measure the degree of disability in patients with PD in daily activities in both ON and OFF medication phases.

Purpose. Since fear of falling may be one of the main problems in people with Parkinson’s disease (PD), its assessment with valid tools is necessary in both drug phases. This study was carried out to investigate the psychometric attributes of the Fall Efficacy Scale-International (FES-I) in people with PD, both in On and Off phases. Methods. One hundred twenty-four patients with PD (mean age ± standard deviation, 60.33 ± 12.59 years) were assessed with the FES-I, both in On- and Off-drug phases. Dimensionality, internal consistency, and test-retest reliability were, respectively, explored by means of factor analysis, Cronbach’s alpha, and Intraclass Correlation Coefficient. Convergent validity of FES-I was established with Visual Analog Scale-Fear of Falling, Berg Balance Scale, and Functional Reach Test. Parkinson’s Disease Questionnaire-39 and Unified Parkinson Disease Rating Scale-Activities of Daily Living were also applied. Discriminative validity was tested between patients with and without a history of falling. Results. Factor analysis showed two factors for On- and one factor for Off-drug phase. Internal consistency (α = 0.96, On phase; 0.98, Off phase) and test-retest reliability (0.94; 0.91) were satisfactory in both drug phases. There was a moderate/high correlation (rS = |0.50–0.70|) between FES-I and Visual Analog Scale-Fear of Falling, Berg Balance Scale, and Functional Reach Test. Parkinson’s Disease Questionnaire-39 and Unified Parkinson Disease Rating Scale-Activities of Daily Living were achieved in both drug phases too. The sensitivity of FES-I to discriminate Parkinson’s disease with and without falls showed moderate effect size in both phases. Conclusion. This study verified that FES-I is unidimensional, reliable, and valid to measure the Fear of Falling during On- and Off-drug phases in people with PD.

Background Pain is one of the most common non-motor symptoms in Parkinson's disease (PD). Using an appropriate and specific measuring tool would be helpful in managing the pain. King's Parkinson's disease Pain Scale (KPPS) is an instrument designed to specifically measure pain in people with PD. Purpose This study aimed to examine the psychometric properties of the Persian version of KPPS (KPPS-P) and its cut-off points for pain severity levels. Methods A total of 480 people with PD (with a mean (SD) age of 60.89 (10.98)) were recruited. The acceptability of KPPS-P was calculated. The structural validity and discriminant validity for different levels of pain was explored via the factor analysis, and Receiver Operating Characteristics (ROC) curves, respectively. Internal consistency, test-retest, and inter-rater reliability were estimated by Cronbach's alpha and Interclass Correlation coefficient (ICC). Convergent validity was established between KPPS-P and other scales including Visual Analog Scale-Pain, Douleur Neuropathic 4, Brief Pain Inventory, Short-form McGill Pain Questionnaire-2, and Parkinson's Disease-8. Results A significant floor effect was observed. The exploratory factor analysis revealed 4 factors. Cronbach's alpha and ICC values were higher than 0.80. The correlation range between KPPS-P and other scales was 0.35−0.76. Cut-off points of 0, 17, and 68 were obtained to discriminate pain severity levels between no pain, mild, moderate, and severe pain, respectively, with sensitivity and specificity above 0.80. Conclusion Our results indicate that the Persian version of KPPS not only has acceptable psychometric properties to assess pain in PD but also has the ability to distinguish between different levels of pain severity.

Introduction In the elderly, functional balance, fear of falling, and independence in daily living activities are interrelated; however, this relationship may change under the influence of drug phase and the severity of disease in individuals with idiopathic Parkinson disease. This study aimed to investigate the association of functional balance, fear of falling, and independence in the Activities of Daily Living (ADL) with the drug on- and drug off-phases. Methods A total of 140 patients with Parkinson disease (age: Mean±SD; 60.51±12.32 y) were evaluated in terms of their functional balance, fear of falling, and independence in their daily activities by the Berg Balance Scale (BBS), Fall Efficacy Scale-International (FES-I), and Unified Parkinson Disease Rating Scale-ADL (UPDRS-ADL), respectively, in drug on- and drug off-phases. The Hoehn and Yahr scale recorded global disease rating. The Spearman coefficient, Kruskal-Wallis, and Mann-Whitney tests were used to find out whether the distribution of scale scores differs with regard to functional balance or disease severity. Results A strong correlation was found between the functional balance, fear of falling, and independence in ADL with both drug phases. The results also showed the significant difference in the distribution of the FES-I and UPDRS-ADL scores with regard to functional balance (except independence in ADL in drug off-phase). Also, the distribution of the scores of BBS, FES-I, and UPDRS-ADL showed significant differences with regard to disease severity. Conclusion The study showed a strong correlation between functional balance, fear of falling, and independence in ADL that can be affected by the drug phase and severity of the disease. However, more studies are needed to understand this relationship precisely.

Background Although anxiety is a common non-motor outcome of Parkinson's disease (PD) affecting 40% of patients, little attention has been paid so far to its effects on balance impairment and postural control. Improvement of postural control through focusing on the environment (i.e. external focus) has been reported, but the role of anxiety, as a confounding variable, remains unclear. Objectives This study aimed to investigate the influence of anxiety and attentional focus instruction on the standing postural control of PD patients. Methods Thirty-four patients with PD (17 with high anxiety (HA-PD) and 17 with low anxiety (LA-PD)), as well as 17 gender- and age-matched healthy control subjects (HC) participated in the study. Postural control was evaluated using a combination of two levels of postural difficulty (standing on a rigid force plate surface with open eyes (RO) and standing on a foam surface with open eyes (FO)), as well as three attentional focus instructions (internal, external and no focus). Results Only the HA-PD group demonstrated significant postural control impairment as compared to the control, as indicated by significantly greater postural sway measures. Moreover, external focus significantly reduced postural sway in all participants especially during the FO condition. Conclusion The results of the current study provide evidence that anxiety influences balance control and postural stability in patients with PD, particularly those with high levels of anxiety. The results also confirmed that external focus is a potential strategy that significantly improves the postural control of these patients. Further investigation of clinical applicability is warranted towards developing effective therapeutic and rehabilitative treatment plans.

Background Depression is one of the common non-motor symptoms in patients with Parkinson disease (PD), which can have a negative effect on the quality of life of the patients. Therefore, it is necessary to have suitable, accurate, cheap, and simple diagnostic tools to identify depression in patients with PD and apply a proper treatment. The current study aimed at comparing the single-item visual analog scale (VAS) with the multi-item hospital anxiety and depression scale (HADS) and patient health questionnaire-9 (PHQ-9) in respect to their sensitivity and specificity to diagnose depression in patients with idiopathic PD. Methods The current cross sectional, comparative study employed the simple non-probability method and selected 79 patients with idiopathic PD, with the mean (SD) age of 59.10 (10.84) years and the average (SD) of disease progression level of 3.24 (1.13), based on Hoehn and Yahr scale. The single-item scale VAS and multi-item tests HADS and PHQ-9 were used as an index tests, and Beck depression inventory (BDI) was employed as the reference test to evaluate depression in 3 levels of lack of (or mild) depression, moderate depression, and severe depression using 90% sensitivity and 90% specificity. To determine the sensitivity, specificity, and the ability of each index test in order to diagnose depression, agreement percent of index tests with reference test and receiver operating characteristic (ROC) analysis were used. Results The results of ROC analysis showed that VAS (AUC = 0.84) and HADS (AUC = 0.87) and PHQ-9 (AUC = 0.85) possessed similar abilities to discriminate depression in patients with PD. The sensitivity of VAS, HADS, and PHQ-9 tests in moderate or greater threshold were 92%, 96%, and 89%, respectively, and in severe threshold were 64%, 79%, and 49%, respectively. Specificity of these tests in moderate or greater threshold were 42%, 50%, and 62%, respectively, and in severe threshold were 88%, 77%, and 88%, respectively. The highest agreement level with BDI in mild/moderate and severe levels of depression were found in VAS and PHQ-9, respectively. Conclusions The single-item scale VAS, similar to multi-item tests HADS and PHQ-9, had a low to high sensitivity and specificity to diagnose depression in moderate or greater and severe thresholds in patients with PD.

Cuprizone (Cup) is a copper chelating agent frequently used to study factors that affect oligodendrocytes (OLGs) death and acute demyelination. Triptolide (TP), a nuclear factor-kappaB (NF-κB) blocker, is a major bioactive component of Tripterygium wilfordii Hook f. (TWHf) with various therapeutic activities. In this study, we examined the effects of TP on neuroglia activation, inflammation, apoptosis, demyelination, and behavioral deficits in the Cup-induced toxic model of multiple sclerosis (MS). C57BL/6 J mice were fed with chow containing 0.2% Cup for 6 weeks to induce detectable neuroinflammation and myelin loss. TP was administered intraperitoneally at different doses (125, 250 or 500 μg/kg/day) during the last week of the Cup challenge. Although TP substantially decreased Cup-induced NF-κB extra activation, TNF-α and IL-1 over expression, and gliosis in a dose-dependent manner, only low dose of TP (TP-125) was able to raise the number of OLGs precursor cells (NG-2+/O4+), reduce Bax/Bcl-2 ratio and improve behavioral deficits. In addition, TP-125 decreased NF-κB activation on GFAP+ astrocytes more than MAC-3+ microglial and MOG+ oligodendrocytes which suggested the possibility of specific dampening of NF-κB signaling in reactive astrocytes. Behavioral assessments by open-field and rota-rod tests showed that only TP-125 notably improved motor function and motor coordination compared to the Cup group. These findings highlight the pivotal role of NF-κB signaling in the oligodendrogenesis and lesion reduction in demyelination diseases such as MS.

Introduction: The following study was carried out in order to translate, cultural adaptation, and determine the content and face validity of the “Patient-Rated Wrist Evaluation” questionnaire with the aim of evaluating the two components of pain and disability in patients with wrist injuries. Material and Methods: The methodology of this survey was non-experimental study. After translation and cultural adaptation according to the Beaton method (approved by the American Surgeon Association), the pilot test was performed on patients with wrist injuries (fractures of the distal radius, scaphoid fractures and carpal tunnel syndrome). To assess content and face validity, the questionnaire was given to 10 specialists (6 of whom were occupational therapists, 2 were physiotherapists, and 2 were orthopaedic surgeons), and 20 patients with wrist injuries. Results: The qualitative content and face validity of the questionnaire for wrist injuries was appropriately reported good. Each item of the content validity ratio was slightly higher than 0.75 and this justified the necessity to include all items. Each item of the content validity index was slightly higher than 0.79. Therefore, all the items were approved in terms of their simplicity, clarity, and relevance. The impact score in order to evaluate the importance of each item was calculated and all were higher than 1.5. Therefore, in terms of face validity all the items were approved. Conclusion: The results showed that the Persian version of the “Patient-Rated Wrist Evaluation” questionnaire for evaluating the pain and disability of wrist injuries was indeed satisfactory, in terms of it’s content and face validity, thus it can be used in patients by specialists and therapists.

This study aimed to investigate the variability in postural sway patterns during quiet standing in stroke survivors. The postural sway was measured in 19 stroke survivors, as well as 19 healthy demographically matched participants, at 3 levels of postural difficulty (rigid surface with closed and open eyes, and foam surface with closed eyes), and 3 levels of cognitive difficulty (without a cognitive task, easy and difficult cognitive tasks). Both linear analyses (the amount of postural sway variability, including the standard deviation of the COP velocity in both the anteroposterior (AP) and mediolateral (ML) directions), as well as non-linear analyses [the temporal structure of the COP variability, including % Recurrence, % Determinism, Shannon Entropy, Trend and the maximum diagonal line (D max)] were employed. The results revealed that the amount of variability of the postural sway of stroke survivors was significantly greater than that of healthy participants, along both the ML and AP directions, with the highest obtained during standing on foam with closed eyes. All measures of the temporal structure of the COP variability were significantly greater in stroke survivors, as compared to the control group, along the ML direction, but not along the AP direction. The cognitive error was significantly higher during difficult cognitive tasks, although it was neither affected by postural difficulty nor by group. The different results obtained for the amount and temporal structure of the COP variability in the AP and ML directions shed light on the intricate mechanisms employed by the CNS in post-stroke balance control, and suggest that effective rehabilitative and therapeutic strategies should be patient-specific, taking both the environment/surface as well as the specific protocols into consideration.

Debate continues about the effect of 3, 4-methylenedioxymethamphetamine (MDMA) on cognitive and mitochondrial function through the CNS. It has been shown that physical exercise has an important protective effect on cellular damage and death. Therefore, we investigated the effect of physical exercise on MDMA-induced impairments of spatial learning and memory as well as MDMA effects on brain mitochondrial function in rats. Male wistar rats underwent short-term (2 weeks) or long-term (4 weeks) treadmill exercise. After completion of exercise duration, acquisition and retention of spatial memory were evaluated by Morris water maze (MWM) test. Rats were intraperitoneally (I.P) injected with MDMA (5, 10, and 15mg/kg) 30min before the first training trial in 4 training days of MWM. Different parameters of brain mitochondrial function were measured including the level of ROS production, mitochondrial membrane potential (MMP), mitochondrial swelling, mitochondrial outermembrane damage, the amount of cytochrome c release from the mitochondria, and ADP/ATP ratio. MDMA damaged the spatial learning and memory in a dose-dependent manner. Brain mitochondria isolated from the rats treated with MDMA showed significant increase in ROS formation, collapse of MMP, mitochondrial swelling, and outer membrane damage, cytochrome c release from the mitochondria, and finally increased ADP/ATP ratio. This study also found that physical exercise significantly decreased the MDMA-induced impairments of spatial learning and memory and also mitochondrial dysfunction. The results indicated that MDMA-induced neurotoxicity leads to brain mitochondrial dysfunction and subsequent oxidative stress is followed by cognitive impairments. However, physical exercise could reduce these deleterious effects of MDMA through protective effects on brain mitochondrial function.

Background: Katz Index is a well-known index for assessing basic activities of daily living. The aim was to determine validity and reliability of the Katz Index in Iranian patients with acute stroke. Methods: Eighty-seven patients (56 male, 31 female) with acute stroke (1-30 days post-stroke) participated in this psychometric properties study. Interval time for retest was 14 days. All participants were Iranian with Persian as native language, had no other major diseases (e.g. cancer, Alzheimer) and no psychiatric disorder. Cognitive mental score of all participants was above 18 (according to Mini-Mental State Examination). If they had another stroke during the following-up period, they were excluded from the study. Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM) and Minimum Detectable Change (MDC) were calculated to investigate the reliability of the KI. Criterion validity of the KI was assessed by Spearman's Correlation Coefficient (ρ). Moreover, Confirmatory Factor Analysis (CFA) and Exploratory Factor Analysis (EFA) were performed to investigate the construct validity of the KI. Results: Inter-rater and intra-rater reliability of Persian Katz Index were reasonable (ICC2,1=0.93, ICC2,1=0.83; respectively). Internal consistency of this index was high (cronbach's alpha=0.79). The high to excellent correlation was found between Katz Index and the motion (ρ=0.88), self-care (ρ=0.98), and total scores (ρ=0.92) of Barthel Index. Factor analysis of the Persian Katz Index indicated two factors including motion (bathing, toileting, and transferring) and self-care (dressing, bowel & bladder control, and feeding). Conclusion: The results of this study suggest that Persian version of Katz Index in patients with acute stroke can be considered as an acceptable clinical instrument in practice and research.

Objectives: One of the most disabling impairments following stroke is upper limb impairment. Despite the important role of somatosensory function in motor control and high prevalence of somatosensory deficits in stroke survivors, little attention has been paid to its effect on UE motor function in chronic stroke survivors. Thus, the aim of this study is to explore the correlation between different somatosensations and manual dexterity as well as UE motor function in these patients. Methods: In this correlational study, 225 chronic stroke survivors (112 female and 113 male) participated, selected by simple non-probability method among the stroke survivors admitted to the rehabilitation centers in Tehran. The lower-order somatosensations, including light touch and wrist Proprioception, were evaluated by Weinstein Enhanced Sensory Test (WEST) and Wrist Position Sense Test (WPST), respectively. The higher-order somatosensations were measured by static and moving 2-Point Discrimination (s2PD and m2PD, respectively), Hand Active Sensation Test (HAST) and Haptic Object Recognition Test (HORT). Gross and fine manual dexterity and UE motor function were assessed using Box-Block Test (BBT), Purdue Pegboard Test (PPT) and Wolf Motor Function Test (WMFT), respectively. Results: The multiple regression models showed that WPST alone accounted for the 38.8- 56.6 of the variance in manual dexterity and UE motor function. The WEST was the second most significant predictor in all regression models. The HORT, m2PD and HAST explained a small percent of the variance in regression models. Discussion: These results suggest that treatments that target somatosensory impairments, especially wrist Proprioception and light touch, may be particularly important for improving manual dexterity and UE motor function in chronic stroke survivors. © 2018, University of Social Welfare and Rehabilitation Sciences.